Standart Perkütan Nefrolitotomi ve Tüpsüz Perkütan Nefrolitotomi Sonuçlarının Karşılaştırılması: Prospektif Randomize Çift Kör Çalışma

Year 2019, Volume: 14 Issue: 3, 160 - 165, 01.10.2019

Huseyin Kocakgol , Senol Adanur Ali Haydar Yilmaz , Fatih Ozkaya İbrahim Karabulut Ozkan Polat

https://doi.org/10.33719/yud.508649

Abstract

Amaç: Standart PNL ve tüpsüz PNL yapılan hasta gruplarının güvenlik,
etkinlik ve hasta konforu açısından karşılaştırılmalarını amaçladık.

Gereç ve Yöntemler: PNL endikasyonu alan 78 hasta çalışmaya alındı.
Standart PNL yapılan 38 hasta Grup I ve tüpsüz PNL prosedürü uygulanan 40 hasta
Grup II olarak randomize edildi. Çalışma prospektif randomize çift kör çalışma
olarak dizayn edildi. Operasyon sonunda aktif kanaması olan ve multipl akses
kullanılan hastalar çalışma dışı bırakıldı. Ameliyat sonrası ağrı ve
komplikasyonların değerlendirilmesinde sırasıyla VAS (visual analogue scale) ve modifiye Clavien
sınıflaması kullanıldı.

Bulgular: Yaş, cinsiyet, taş boyutu, taşların böbrekteki lokalizasyonları,
taraf gibi demografik verilerde iki hasta grubu arasında istatistiksel fark
yoktu (P>0,05). Yine perioperatif verilerde; operasyon süresi, skopi süresi,
taşsızlık oranları, peroperatif kreatin ve hemoglobin değişimi, kan
transfüzyonu, VAS 2-VAS 3 ağrı skorları, analjezik gereksinimi, ateş ve ek
cerrahi gerektiren komplikasyonlarda iki grup arasında istatistiksel fark
bulunmadı (P>0,05). VAS 1 skoru ve hastanede kalış süreleri açısından her
iki grup karşılaştırıldığında, her iki parametre tüpsüz PNL grubunda
istatistiksel olarak anlamlı düşük bulundu (P=0,003).

Sonuç: Tüpsüz PNL operasyonu,
erken postoperatif dönemde daha az ağrı ve kısa hastanede kalış süresi gibi
avantajları ve standart PNL operasyonuna göre anlamlı olmayacak derecede düşük
komplikasyon oranları ile deneyimli cerrahlar tarafından etkin ve güvenle
uygulanabilecek endoürolojik bir yöntemdir.    

Keywords

Böbrek taşları , Perkütan nefrolitotomi , Standart PNL , Tüpsüz PNL , Ağrı , Hastanede kalış süresi

A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study

Abstract

Aim: We aimed to compare patient groups who underwent either a standard
percutaneous nephrolithotomy (PNL) or tubeless PNL for safety, effectiveness
and patient comfort.

Material and Methods: 78 patients were included in the study. Patients who underwent the
standard PNL (n=38) or tubeless PNL (n=40)
were randomized into Groups 1 and 2, respectively. This study was designed as a
prospective, randomized, double-blind investigation. Patients who had active
bleeding at the end of the operation and those with multiple access tracts were
excluded from the study. To
evaluate postoperative pain and complications, a visual analogue scale (VAS)
and a modified Clavien classification were used, respectively.

Results: A statistically
significant difference was not found between the two patient groups for demographic
data (age and gender), or for size, laterality, and intrarenal location of the
stone(s) (p>0.05). Perioperative data, including operative and fluoroscopy times and stone‑free rates, perioperative changes in
creatinine and haemoglobin values, blood transfusion, VAS 2 to 3 pain scores,
analgesic requirements, fever and complications requiring additional surgical
treatment were not statistically different between groups (p>0.05). A
VAS 1 pain score and hospital stays were significantly decreased in the tubeless
PNL group (p=0.003).

Conclusions: Tubeless
PNL surgery is an effective and safe endourological procedure that can be
performed by experienced surgeons. Its advantages over standard PNL include
less pain during the early postoperative period, shorter hospital stays but the
rates of complications are not significantly lower.

Keywords

Renal stones , Percutaneous nephrolithotomy , Standard PNL , Tubeless PNL , Pain , hospitalization time

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